Making Health and Development a Reality for the people of India
Tuberculosis Prevention
Background

Tuberculosis (TB) remains one of the world’s deadliest communicable diseases. In 2013, an estimated 9.0 million people developed TB and 1.5 million died from the disease, 360 000 of whom were HIV-positive and India alone accounted for 24% of total cases with an annual incidence of 2.1 million new cases. About 2.6 million people live with HIV and 1.2 million are TB-HIV co-infected. With 99000 cases annually, India has one of the highest multidrug-resistant TB (MDR-TB) patients.

In India, MDR-TB in new cases is estimated at 3% and in previously treated cases at 12-17%. (Source: TB India 2012 – Annual Status Report, Central TB Division, Directorate General of Health Services, Ministry of Health and Family welfare). Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is a renewed endeavor to support and promote Revised National Tuberculosis Control Programme (RNTCP) with an aim to reduce TB-related morbidity and mortality in India as also to accelerate progress towards achieving the targets of the Global Stop TB Strategy for 2006-2015. Project Axshya (meaning “TB Free”) which is being implemented by a consortium of 16 civil society organisations led by The Union & World Vision India aims at improving the reach, visibility and effectiveness of RNTCP through civil society support in 374 districts across 23 states covering a population of 750 million by 2015. The select districts include more than 200 underperforming districts, 82 'poor and backward' districts, difficult areas (like the north-east and Jammu & Kashmir), and 44 predominantly tribal districts. It also aims at scaling up care and management of Drug Resistant TB (DR-TB) in 35 states/Union Territories of India resulting in the initiation of treatment of 55,350 additional cases of DR-TB by 2015.

The guiding principles for Project Axshya are universal access to quality TB services, community participation in TB care and control, sustainable interventions, and equitable distribution of project benefits with social and gender sensitivity. Project Axshya also aligns with the Stop TB Strategy of World Health Organization (WHO) to achieve the Millennium Development Goals (MDGs).
Urban Intervention
Project Axshya (meaning TB-Free), was launched in 2010 as a Civil Society component funded by The Global Fund Round-9.The UNION as a principal recipient along with eight implementing partners as Sub Recipients is implementing Axshya Phase III in 285 districts and 40 Urban sites across 19 states.VHAI is implementing in 46 districts across 8 states and 2 cities (Urban) as a leading SR of the UNION

Need For Urban Intervention
Studies on health seeking behaviour in India show that more than half of TB patients in India first approach the private health care sector, where TB diagnosis is often missed.The Project Axshya aims to systematically involve various health sectors, especially Private Practitioners which will lead to an increase in case detection and consequently have successful treatment outcomes.
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Process of Implementation

Voluntary Health Association of India (VHAI) with its headquarters in New Delhi is implementing Project AXSHYA in 46 districts across 8 states. Project activities in a particular district level are carried out with the support of at least four local NGOs.

The project undertakes various advocacy, communication and social mobilization interventions in order to involve community members and village opinion leaders to:

  1. Strive towards a better care- seeking approach of TB-symptomatic persons;
  2. Demystify locally prevalent myths and misconceptions;
  3. Sensitize, disseminate and promote adoption of the Patients' Charter for TB Care among all stakeholders;
  4. Create a forum for TB care in each district with the participation of women, cured patients, tribal populations and senior citizens;
  5. Improve the cure rate to more than 85 percent at the end of three years and reduce the average default rate to less than 10 percent; and
  6. Improve the new sputum positive case detection rate to more than 70% at the end of three years.
Geographical Coverage
VHAI Project Field Area

Sr.No.

State

Districts

1

Punjab

Fatehgarh Sahib, Hoshiarpur, Jalandhar, Ludhiana, Mohali, Sangrur, Amritsar, Muktsar, Moga, Tarn taran

2

Madhya Pradesh

Bhind, Bhopal, Indore, Morena, Neemuch, Panna,Rewa, Satna

3

Bihar

Darbhanga,Jehanabad, Kathihar, Kishanganj, Lakisarai, Munger, Purnia, Sheikhupura, Vaishali

4

Rajasthan

Barmer, Dausa, Dungarpur, Jodhpur, Nagaur, Sirohi

5

Uttar Pradesh

Chandauli, Kannauj, Kaushambi, Kushinagar, Azamgarh

6

Jammu & Kashmir

Badgam, Baranula, Pulwama, Srinagar

7

Manipur

Senapati, Tamenglong, Thoubal

8

Goa

North-Goa



Please view the Map depicts the spread of Project AXSHYA in 8 states across 46 districts
Current Update
Axshya Project has been an unique experience reaching to the vulnerable and marginalized pockets by creating a direct dialogue with the community. With its innovations and the proactive approach it has maintained it’s A+ grading in the Global Fund continuously. The project has been shifted to Phase III from October 2015 to December 2017 with special emphasis to the contact tracing and ensuring complete treatment of diagnosed TB patients. VHAI has been given responsibility for urban intervention (urban slums and unorganized areas) in the urban interventionin two cities Indore (Madhya Pradesh) and Srinagar (Jammu & Kashmir).

VHAI Contribution to the RNTCP through project: The project has focused to reach the vulnerable and marginalized pockets and counsel the chest symptomatic to avail the diagnosis and prevented lives of the people in the process. We could identify 8477 TB patients and it was ensured that they take their complete treatment by regular interaction.

VHAI AXSHYA PROJECT - KEY ACHIEVEMENTS

Period: April 2013 to February 2016

 Community Leaders Reached

396606 

 Community members reached through Axshya Samvad

1074399nbsp;

 Tuberculosis suspects identified through activities

61704 

 Tuberculosis Positive found put on DOTS

8477 

 Default Retrieval/Treatment Interrupters

707 


Axshya Samvad: Direct dialogue with the chest symptomatic in the vulnerable pockets has been unique approach in the tuberculosis prevention. Over 1.1 million households have been met in person with this intervention and the yield of TB patients was more than 60 per cent from this approach which is given in the following diagram:

World TB Day: Out of 46 Axshya Districts, there has been World TB Day celebration in 39 districts. The community in large has been sensitized for the TB prevention in this event which has been as under:
a) Public Rally
b) Health Camps in the marginalized and vulnerable pockets
c) Sputum test during the health camps including HIV test for the HRGs
d) Media slogans through public transport and the auto-rickshaws
e) Coordination of World TB day through District RNTCP officials
f) Distribution of IEC material to the community in local dialects.



Special event: Collective attempt was made by team Punjab to create large scale awareness about the symptoms of tuberculosis by designing and printing 12000 awareness stickers (1200 for each district). The stickers were launched in various districts by high level dignitaries including Mr. Surjit Kumar Jayani Health Minister, Dr. Navjot Kaur Sidhu Chief Parliamentary Secretary (Health), S. Prem Singh Chandumajra Member Parliament apart from Civil Surgeons and District T.B. Officers.





Prison Intervention: We have been able to sensitize1381 prisoners for prevention in Tuberculosis by one to one discussion and conducting meetings in Punjab and Madhya Pradesh. This approach had been beneficial to the chest symptomatic among the prisoners to prevent the large community. This had been conducted with the RNTCP officials and the technical staff who organized their check-up at the prison premises and provided relief to the symptomatic.

Prison intervention has been a Global Fund target where the prisoners are given facility for the sensitization on TB prevention, HIV, Alcoholism, Tobacco Consumption and lifestyle disorders. Some confessions from the prisoners were:
  • Don’t treat prisoners to wear mask in the public places and brand as TB patients. At open space they are as free as other prisoners – Dr.B.L. Mishra, District TB Officer, Rewa, MP
  • I have a vision to get all prisoners tested for TB and HIV and Axshya Project is providing active support to the Jail. – Jail Superintendent, Kannauj, UP
  • The prisoners feel homely when the communicable diseases are discussed among us by the social workers and the health personnel. – Prisoners, Javad Jail, Nimuch.
  • Thanks to the Axshya and the RNTCP officials for being counselors to the prisoners – Jail Superintendent, Amritsar, Punjab

Specific achievements and landmarks through project:

1. The community volunteers and the rural health care providers have been recognized as change agents in the TB prevention through project. The outreach to the vulnerable pockets has been recognized from the RNTCP and the public sector.

2. The urban slums have been neglected for the health care specifically in the TB prevention, TB-HIV cross referral, counseling for the individuals those do not have access to the health services. The urban intervention has been very helpful and the health services are their doorsteps.

Supportive Supervision Visit Plan for the Quarter:

The focus has been to strengthen the Urban Intervention activities in Indore and Srinagar and Executive Director/National Program Manager and the Medical Consultant has been scheduled. Similarly, orientation training and other programs planned are:

a) Induction training for the newly appointed DCs and Medical Consultant at VHAI 7-8 June 2016;
b) Grant Monitoring visit with the Union team at Hoshiarpur Punjab and Jehanabad Bihar;
c) State RNTCP Review Meeting participation in Rajasthan, Punjab and Bihar
d) Dialogue with the low performing district NGO partners in Manipur – 14-18 June 2016
e) Urban Intervention – visit of National Program Manager and Medical Consultant to Srinagar and Indore – 14-25 June 2016.
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